Expanding the Supply of High Quality Public Schools

Two levers that play critically important roles in determining how quickly and consistently successful schools and design models can be replicated. One is the degree of managerial responsibility, support, and control the organization chooses to exercise. The other is related to specificity of school design.This paper examines the school development landscape in the context of these levers, with examples of organizations that have chosen different paths with different tradeoffs and outcomes

Ethical Allocation of Preexposure HIV Prophylaxis

Civil society-led movements transformed global AIDS action from deep skepticism about extending anti-retroviral (ARV) treatment in low and middle-income countries to an historic scaling up of treatment towards universal access. The AIDS movement, however, is at an inflection point due to the interplay of key health and economic determinants—the global financial downturn, tight foreign aid budgets, and intense resource competition. Policy makers will now have to consider implementation of a new intervention—pre-exposure prophylaxis (PrEP), which could mean a diversion of ARVs from treatment to prevention. The principle underlying PrEP is that ARVs could prevent HIV infection among people who are HIV-negative and at high risk. Unlike existing prevention strategies such as voluntary counseling and testing (VCT), condoms, and male circumcision, PrEP is a continuous biomedical intervention. Although it will take several years to fully establish the clinical efficacy of PrEP in varying populations, the encouraging early results from CAPRISA, iPrEx, and CDC 4323 have accelerated global dialogue on its proof of deliverability. The studies encompass diverse populations, including injecting drug users (IDUs), MSM, serodiscordant heterosexual couples, and sex workers. These studies will be completed at different times, raising the question: if a trial demonstrates effectiveness for a given study group, should PrEP be used for others? The ethical issues raised by PrEP are difficult, but not insurmountable. Examining comparative cost-effectiveness, good governance, overcoming access barriers, and ensuring quality improvement would help ensure ethical allocation under circumstances of scarcity

Can we trust cluster-corrected standard errors? An application of spatial autocorrelation with exact locations known

Standard error corrections for clustered samples impose untested restrictions on spatial correlations. Our example shows these are too conservative, compared with a spatial error model that exploits information on exact locations of observations, causing inference errors when cluster corrections are used

Experiences of adults abused as children after discharge from inpatient treatment: Informal social support and self-care practices related to trauma recovery

This qualitative study explored adults’ perceptions of experiences that were helpful and unhelpful to their recovery from the traumatic effects of childhood physical and sexual abuse. The authors conducted in-depth interviews with 30 participants approximately 6 months after discharge from an inpatient trauma treatment program. Participants reported that barriers to recovery postdischarge were lack of follow-up support immediately after discharge, social isolation, lack of friends, problems with partners, and lack of emotional support from family members. Facilitating factors were concrete support from family and friends; emotional support, particularly from friends; developing a social network unrelated to the abuse history; and continuing self-care strategies learned in the inpatient program. Implications for community-based mental health professionals are discussed

The O’Neill Institute for National and Global Health Law: Discovering Innovative Solutions for the Most Pressing Health Problems Facing the Nation and the World

The connection between health and an individual’s ability to function in society, as well as the importance of health to a society’s economic, political, and social wellbeing necessitates finding innovative solutions to the world’s most pressing health problems. The O’Neill Institute for National and Global Health Law at Georgetown University seeks to demonstrate the role that academia can play in addressing complex national and global health problems in a comprehensive, evidence-based, intellectually-rigorous, and nonpartisan manner. The O’Neill Institute currently has three research programs: global health law, national health law, and the center for disease prevention and outcomes. Projects within these programs examine a broad range of health law and policy issues, such as global health governance, global tobacco control, health worker migration, emergency preparedness, national and Chinese health reform, HIV and AIDS issues, food safety, and personalized medicine. These projects merge the scholarly capacity within the institute with the resources of its partners, which include the World Health Organization, World Bank, the Bill & Melinda Gates Foundation, the U.S. Centers for Disease Control and Prevention, and the Campaign for Tobacco Free Kids. Additionally, the faculty and fellows of the O’Neill Institute regularly produce high-level scholarship and engage in teaching offering multi-disciplinary course offerings and innovative graduate degree programs. URL: http://www.law.georgetown.edu/oneillinstitute/documents/2010-03-09_oneill-solutions.pdf; http://mjlst.umn.edu/uploads/Pf/V1/PfV1QhiCT6lUOsv1AqDTCA/111_gostin.pdf

Clinical Observation Reflections from Students in an Interdisciplinary Palliative Care Course

The purpose of this study was to gain insight into how a brief clinical observation encounter contributed to students’ experiences in an interdisciplinary palliative care course. This course was required of all graduate nursing students and was available as an elective for medical and other healthcare professions students at a healthcare sciences university. The students were required to spend approximately 8 to 12 hours attending interdisciplinary team meetings or accompanying a team on rounds and patient visits. The students’ summary narratives of their observation experience were analyzed in this qualitative study that focused on six categories of feedback: (1) patients’ and families’ reactions, (2) communication issues with patients and families, (3) how the palliative care team speaks with the patient and family, (4) communication within the interdisciplinary team, (5) students’ reflections, and (6) students’ suffering. This study demonstrated that a clinical observation activity can be a valuable introduction to palliative care principles for healthcare students in an interdisciplinary course. Students benefited from gaining insight into family/practitioner communications regarding difficult issues, interdisciplinary roles and cooperation, and application of palliative care principles to clinical practice. Further research is required to identify appropriate interventions to deal with student distress resulting from such early career clinical encounters

Child Abuse Reporting: Rethinking Child Protection

The general public has been bewildered by the magnitude of sex abuse cases and the widespread failure by pillars of the community to notify appropriate authorities. The crime of sexually abusing children is punishable in all jurisdictions and this article examines the duty to report suspected cases by individuals in positions of trust over young people, such as in the church or university sports. The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child maltreatment as an act or failure to act on the part of a parent or caregiver that results in death, serious physical or emotional harm, sexual abuse, or exploitation, and establishes minimum federal standards. Each state has its own definitions of maltreatment and every state identifies persons who are required to report child abuse. As such, state law is highly variable in defining who has a mandatory duty to report, and clergy and other individuals in close supervision of children (e.g., athletic coaches, scout leaders, volunteers in religious programs, and university officials) may necessarily hold such duty. The article outlines why there are strong moral reasons the law should require all adults in close supervision of children to report any individual who they have good reason to believe has abused a child and moreover outlines how to ensure prompt reporting of abuse, while still ensuring that respected individuals are not falsely accused

The nutritional transition and diet-related chronic diseases in Asia

The nutritional transition currently occurring in Asia is one facet of a more general demographic/nutritional/epidemiological transition that accompanies development and urbanization, marked by a shift away from relatively monotonous diets of varying nutritional quality toward an industrialized diet that is usually more varied, includes more preprocessed food, more food of animal origin, more added sugar and fat, and often more alcohol. This is accompanied by shift in the structure of occupations and leisure toward reduced physical activity, and leads to a rapid increase in the numbers of overweight and obese. The accompanying epidemiological transition is marked by a shift away from endemic deficiency and infectious diseases toward chronic diseases such as obesity, adult-onset diabetes, hypertension, stroke, hyperlipidaemia, coronary heart disease, and cancer. Obesity is now a major public health problem in Asia. Obesity is a problem of the urban poor as well as the rich, and the urban poor have the added predisposing factors associated with low birthweight. Costs of chronic disease are estimated for China and Sri Lanka. Diet-related chronic disease is projected to increase and dietary factors (principally overweight) will account for an increased share of chronic disease, and childhood factors will decline in significance. Few program and policy options to address these issues have been undertaken in Asia. Agricultural policy is important, and the relatively cheap availability of vegetable oil may have had dramatic (adverse) dietary effects in Asia. Price policy has considerable potential, in particular the pricing of oils. Promoting a traditional diet has been quite helpful in holding down fat intake and obesity in Korea. Health promotion efforts in Mauritius succeeded in reversing several adverse trends contributing to coronary heart disease. Thailand has successfully used mass media for other health promotion efforts and is moving to pilot schemes in the area of chronic disease. And Singapore has been the leader in the region in exercise promotion and weight control in schools.Urbanization Asia ,Nutritionally induced diseases Asia. ,Diet Developing countries. ,Public health Developing countries ,

The nutritional transition and diet-related chronic diseases in Asia

The nutritional transition currently occurring in Asia is one facet of a more general demographic/nutritional/epidemiological transition that accompanies development and urbanization, marked by a shift away from relatively monotonous diets of varying nutritional quality toward an industrialized diet that is usually more varied, includes more preprocessed food, more food of animal origin, more added sugar and fat, and often more alcohol. This is accompanied by shift in the structure of occupations and leisure toward reduced physical activity, and leads to a rapid increase in the numbers of overweight and obese. The accompanying epidemiological transition is marked by a shift away from endemic deficiency and infectious diseases toward chronic diseases such as obesity, adult-onset diabetes, hypertension, stroke, hyperlipidaemia, coronary heart disease, and cancer. Obesity is now a major public health problem in Asia. Obesity is a problem of the urban poor as well as the rich, and the urban poor have the added predisposing factors associated with low birthweight. Costs of chronic disease are estimated for China and Sri Lanka. Diet-related chronic disease is projected to increase and dietary factors (principally overweight) will account for an increased share of chronic disease, and childhood factors will decline in significance. Few program and policy options to address these issues have been undertaken in Asia. Agricultural policy is important, and the relatively cheap availability of vegetable oil may have had dramatic (adverse) dietary effects in Asia. Price policy has considerable potential, in particular the pricing of oils. Promoting a traditional diet has been quite helpful in holding down fat intake and obesity in Korea. Health promotion efforts in Mauritius succeeded in reversing several adverse trends contributing to coronary heart disease. Thailand has successfully used mass media for other health promotion efforts and is moving to pilot schemes in the area of chronic disease. And Singapore has been the leader in the region in exercise promotion and weight control in schools.Urbanization Asia ,Nutritionally induced diseases Asia. ,Diet Developing countries. ,Public health Developing countries ,